At times it is necessary to tran sfer a person from a nursing facility to a hospital. There are a number of appropriate reasons to hospitalize a nursing home   resident. There may be an infection that is not responding to treatment.  Surgery may be necessary (for example, for a fractured hip) or the resident needs a procedure that is not performed at the nursing home. People who are receiving comfort (palliative) care can also benefit from hospitalization if it will contribute to that comfort.

It is very important to understand, however, that there are risks to hospitalizing a frail, seriously ill geriatric patient.  Some of these are: 

    Increased use of physical and chemical restraints, usually because of hospital procedures in progress (although hospitals now limit the use of restraints). 

    Increased risk of infection, sometimes with organisms resistant to many antibiotics. 

    Anxiety caused by unfamiliar surroundings, especially if dementia is present. 

    The hospital transfer itself can be a source of stress and discomfort for a very frail person. 

        The increased risk of delirium (acute confusion), which can be a medical emergency. 

 For a very frail resident, the best time to decide whether hospitalization should be undertaken in an emergency is before that emergency occurs.  Either the resident or the designated representative can make the decision.  As not all situations can be anticipated, the decision on hospitalization can be changed if unusual circumstances occur. 

The nursing facility is considered the long term resident’s home; the staff usually tries to keep the resident here for treatment unless hospitalization is truly necessary and likely to be beneficial.  And the nursing home is one of the best places for the delivery of palliative care.   

Key Points 

       Hospitalization can be helpful, and in fact life saving, to a nursing home resident in some situations. 

      There are, however, significant risks to hospitalizing a frail, older person, especially if dementia is present.  These include stress, anxiety, confusion, restraints, and infection. 

      Advance care planning permits decisions about care to be made before emergencies occur. 

       A “Do Not Hospitalize” order can prevent an unwanted trip to the hospital in the middle of the night. 

       Many of the our residents are receiving end of life care.This comfort care is  usually best given in the familiar surroundings of the nursing home.